The study explored the effect of veterans’ race and of the pairing of veterans’ and clinicians’ race on the process and outcome of treatment for war-related posttraumatic stress disorder (PTSD). As part of the national evaluation for the PTSD Clinical Teams program of the Department of Veterans Affairs, data on assessment of 4,726 white and black male veterans at admission to the program and on the race and other characteristics of their 315 primary clinicians were obtained. Measures of service delivery and treatment emphasis were obtained 2, 4, 8, and 12 months after program entry, along with clinicians’ ratings of improvement….Although no differences were noted on most measures, the pairing of black veterans with white clinicians was associated with receiving fewer services. According to some other measures, black veterans received less intensive services regardless of the clinician’s race.

“Empirical studies conducted in recent decades have suggested that ethnic minorities are less likely to use outpatient mental health services than whites, receive fewer mental health services, tend to be treated by less well trained professionals, and derive less benefit from treatment…The reasons for these racial/ethnic differences remain unclear but may reflect ethnoculturally based attitudes and behaviors of patients, clinicians (most of whom are white), or—as is most likely—both.”

In a comparison of black and white veterans, “there were significant differences between black and white veterans on 10 measures of participation but on none of the improvement ratings…. On average, blacks were seen for 19% fewer months, had 32% fewer sessions, and scored almost 20% lower on clinicians’ ratings of attendance and commitment to treatment….In comparison with whites, blacks had treatment sessions that involved less discussion of war trauma, less insight-oriented psychotherapy, and less use of psychotropic medication.

With regard to clinician-veteran pairings, “Significantly more of the white clinicians’ black patients than of their white patients and black clinicians’ white patients terminated within 3 months, and significantly more white patients of the white clinicians than the black clinicians terminated within 3 months…When treated by either black or white clinicians, black veterans were rated by their clinicians as having poorer attendance than white veterans, seemed less committed to treatment, received more treatment for substance abuse, and were less likely to be prescribed antidepressant medication.”

“This evidence of problematic racial pairing is likely to be a product of both the fears and anxieties of white clinicians with respect to black veterans and the distrust and suspiciousness of black veterans towards white clinicians.”